Appeals court upholds health care law

By Joan Biskupic, USA TODAY

WASHINGTON  A federal appeals court Wednesday upheld the government's new requirement that most Americans buy health insurance, in the first decision by a U.S. appeals court on the centerpiece of the Obama-sponsored health care overhaul.

By J. Scott Applewhite, AP

President Obama signs the health care bill in the East Room of the White House.

President Obama signs the health care bill in the East Room of the White House.

The ruling by the Cincinnati-based U.S. Court of Appeals for the 6th Circuit gives the administration a significant victory. Yet the 2-1 panel decision marks what is likely to be the first in a series of appeals court rulings in upcoming months. Ultimate resolution of the politically charged dispute is likely to come from the U.S. Supreme Court sometime next year.

Wednesday's decision, however, is the most significant to date, because it is the first by an appeals court and constitutes the first time that a Republican-appointee has voted to uphold the law.

Prior rulings were issued by district court judges, on the first rung of the U.S. judiciary, and in all of those, GOP-appointed judges had struck down the mandate that Americans buy insurance by 2014 and Democratic appointees had found it constitutional.

In Wednesday's case, Judge Boyce Martin, named by President Carter, a Democrat, and Judge Jeffrey Sutton, an appointee of Republican President George W. Bush, joined together for the panel majority to declare the individual-mandate provision a valid use of congressional power.

Sutton's stance was additionally important because he is one of the most high-profile conservative judges nationwide. A former law clerk to Supreme Court Justice Antonin Scalia, Sutton was, before joining the 6th Circuit in 2003, at the vanguard of advocates arguing for limited federal power and confined readings of constitutional rights. He served in the late 1990s as Ohio's state solicitor general.

The overriding question in the health care litigation has been whether Congress, after finding that the uninsured pass on billions of dollars in costs to people who carry insurance, exceeded its commerce power by requiring almost everyone to purchase insurance.

A focal point of the legal arguments has been whether a person's decision not to buy insurance is a kind of economic activity that constitutes commerce, or a kind of inactivity beyond the reach of Congress.

"The minimum coverage provision regulates activity that is decidedly economic," Judge Martin wrote as he took the lead on Wednesday's decision in Thomas More Law Center v. Obama. "Consumption of health care falls squarely within (Supreme Court precedent's) definition of economics, and virtually every individual in this country consumes these services."

Martin concluded his part of the opinion by saying, "Congress had a rational basis for concluding that the minimum coverage provision is essential to the Affordable Care Act's larger reforms to the national markets in health care delivery and health insurance."

Sutton agreed that the individual mandate falls within Congress' power to regulate commerce, in an opinion that emphasized the activity behind making an insurance choice.

"No one is inactive when deciding how to pay for health care," he wrote.

Taking on some of the larger policy questions that have led congressional Republicans to continue trying to roll back the law, Sutton wrote, "The basic policy idea, for better or for worse (and courts must presume better), is to compel individuals with the requisite income to pay now rather than later for health care. Faced with $43 billion in uncompensated care, Congress reasonably could require all covered individuals to pay for health care now so that money would be available later to pay for all care as the need arises."

Sutton noted that critics have argued that if the individual mandate is upheld, Congress would have the leeway to compel other purchases, including, he wrote for example, health club memberships.

But, Sutton wrote, "in most respects, a mandate to purchase health insurance does not parallel those other settings or markets."

Sutton concluded by looking back at great debates over Congress' power and said, "Today's debate about the individual mandate is just as stirring, no less essential to the appropriate role of the National Government and no less capable of political resolution. Time assuredly will bring to light the policy strengths and weaknesses of using the individual mandate as part of this national legislation, allowing the peoples' political representatives, rather than their judges, to have the primary say over its utility."

Dissenting was Judge James Graham, an appointee of President Reagan. He said Congress intruded on the business of the states with the mandate.

The two other appeals courts that already have heard similar disputes are the Richmond-based 4th Circuit and Atlanta-based 11th Circuit. The U.S. Court of Appeals for the District of Columbia Circuit will hear an appeal in early fall.

The health care overhaul, which was immediately challenged after its spring 2010 passage, attempts to make health care coverage more affordable — extending insurance to 32 million Americans — and to reduce the current uncompensated care that causes higher premiums for people who do carry insurance.

Wednesday's case in the 6th Circuit traced to Michigan when the conservative Thomas More Law Center challenged the law. Among the cases still pending is one brought by 26 states that contend Congress lacked the authority to force people to buy insurance.

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